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Epstein-Barr Virus Antibodies

Also known as: EBV Antibodies; EBV VCA-IgM Ab; EBV VCA-IgG Ab; EBNA-IgG Ab; EA-D IgG Ab
Formal name: Epstein-Barr Virus Antibody to Viral Capsid Antigen, IgM; Epstein-Barr Virus Antibody to Viral Capsid Antigen, IgG; Epstein-Barr Virus Antibody to Nuclear Antigen, IgG; Epstein-Barr Virus Antibody to Early D Antigen, IgG; Heterophile Antibodies
Related tests: Mono; Complete Blood Count; White Blood Cell Count

At a Glance

Why Get Tested?

To help diagnose mononucleosis (Mono); to help evaluate susceptibility to EBV infection; to distinguish between an EBV infection and another illness with similar symptoms

When to Get Tested?

When you have symptoms of Mono but a negative Mono test; when a pregnant woman has flu-like symptoms; sometimes when an asymptomatic person has been exposed to Mono

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

The Test Sample

What is being tested?

Epstein-Barr virus (EBV) antibodies are a group of tests that are ordered to help diagnose a current, recent, or past EBV infection. EBV is a member of the herpes virus family. Passed through the saliva, the virus causes an infection that is very common. According to the Centers for Disease Control and Prevention (CDC), as many as 95% of people in the United States will have been infected by EBV by the time they are 40 years old. After exposure to the virus, there is an incubation period of several weeks. EBV then causes an acute primary infection, followed by resolution and dormancy. Latent EBV remains in the person’s body for the rest of his life, reactivating intermittently, but causing few problems unless the person’s immune system is significantly compromised.

Most people are infected by EBV in childhood and experience few or no symptoms, even in the acute phase of the infection. However, when the initial infection is delayed until adolescence, EBV causes infectious mononucleosis (Mono) in about 35 – 50% of those infected. Mono is a condition that is associated with fatigue, fever, sore throat, swollen lymph nodes, an enlarged spleen, and, sometimes, an enlarged liver. Those who have it are usually symptomatic for a month or two before the initial infection resolves.

Patients with Mono are diagnosed by their symptoms and the findings of a complete blood count (CBC) and a Mono test (which tests for a heterophile antibody). A certain percentage of those who have mono will have a negative mono test; this is especially true with children. EBV antibodies can be used to determine whether or not the symptoms these patients are experiencing are due to a current infection with the EBV virus.

It can be important to distinguish EBV from other illnesses. For instance, the enlarged spleen of those with a Mono infection is vulnerable to rupture. Patients who have Mono should not be involved in contact sports for several weeks to months after infection, as a ruptured spleen can cause a medical emergency. Also, pregnant women with symptoms of a viral illness need to be able to distinguish a primary EBV infection, which has not been shown to affect the baby, from a cytomegalovirus (CMV), herpes simplex virus, or toxoplasmosis infection, as these illnesses can cause complications during the pregnancy and may damage the fetus. It can also be important to rule out EBV and to look for other causes for the symptoms. Patients with strep throat, for instance, need to be identified and treated with antibiotics. A patient may have strep throat instead of Mono, or they may have both conditions at the same time.

There are several EBV antibodies. They are proteins produced by the body in an immune response to several different Epstein-Barr virus antigens. They include IgM and IgG antibodies to the viral capsid antigen (VCA), IgG antibodies to the D early antigen (EA-D), and antibodies to the nuclear antigen (EBNA). During a primary EBV infection, each of these EBV antibodies appears independently on its own time schedule. The VCA-IgM antibody appears first and then tends to disappear after about 4 to 6 weeks. The VCA-IgG antibody emerges, is at its maximum at 2 to 4 weeks, then drops slightly, stabilizes, and is present for life. The EA-D antibody appears during the acute infection phase and then tends to disappear within 3 to 6 months, but about 20% of those infected will continue to have detectible quantities of the EA-D antibody for several years after the EBV infection has resolved. The EBNA antibody does not usually appear until the acute infection has resolved. It usually develops about 2 to 4 months after the initial infection and is then present for life. Using a combination of these EBV antibody tests, a doctor is able to detect an EBV infection and to determine whether it is a current, recent, or past infection.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

How is it used?

Epstein-Barr Virus (EBV) antibodies are used to help diagnose Mono if you are symptomatic but have a negative Mono test. The Centers for Disease Control and Prevention (CDC) recommend ordering:

  • Viral capsid antigen (VCA)-IgM, VCA-IgG and D early antigen (EA-D) — to detect a current or recent infection
  • VCA-IgG and Epstein Barr nuclear antigen (EBNA) — to detect a previous infection

In pregnant women with symptoms of a viral illness, one or more of these EBV antibodies may be ordered along with tests for CMV, toxoplasmosis, and other infections (sometimes as part of a TORCH screen) to help distinguish between EBV and conditions that may cause similar symptoms. Occasionally, a VCA-IgG or other EBV antibody may be repeated 2-4 weeks after the first test, either to see if a test changes from negative to positive or to measure changes in antibody concentrations to see if they rise or fall.

A VCA-IgG test, and sometimes an EBNA test, may be ordered on an asymptomatic patient to see if that person has been previously exposed to EBV or is susceptible to a primary EBV infection. This is not routinely done, but it may be ordered when a patient, such as an adolescent or an immune compromised patient, has been in close contact with a person who has Mono.

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When is it ordered?

EBV antibodies may be ordered when you have symptoms suggesting Mono, but a negative Mono test and when a pregnant woman has flu-like symptoms and the doctor wants to determine whether the symptoms are due to EBV or another microorganism. Signs and symptoms may include:

  • Fatigue
  • Fever
  • Sore throat
  • Swollen lymph glands
  • Sometimes enlarged spleen and/or liver

VCA-IgG and EBNA may be ordered whenever your doctor wants to establish previous exposure. Testing may occasionally be repeated when your doctor wants to track antibody concentrations and/or when the first test was negative, but your doctor still suspects that your symptoms are due to EBV.

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What does the test result mean?

If you have positive VCA-IgM antibodies, then it is likely that you have a current, or had a very recent, EBV infection. If you also have symptoms associated with Mono, then it is most likely that you will be diagnosed with Mono, even if your Mono test was negative. If you also have positive VCA-IgG and EA-D IgG concentrations, then it is highly likely that you have, or recently had, an EBV infection.

If the VCA-IgM is negative but the others and an EBNA antibody are positive, then it is likely that you had a previous EBV infection. If you are asymptomatic and are negative for VCA-IgG, then you have not been previously exposed to EBV and are vulnerable to infection. In general, rising VCA-IgG levels tend to indicate an active EBV infection, while falling concentrations tend to indicate a recent EBV infection that is resolving. However, care must be taken with interpreting EBV antibody concentrations as the amount of antibody present does not correlate with the severity of the infection or with the length of time it will last. High levels of VCA-IgG may be present and may persist at that concentration for the rest of your life.

Below, results are provided in table form.

Test results most likely indicate the following:
EBV antibody test
 susceptile to ebv
 current ebv infection
 Past ebv infection
 comments
VCA-IgM
+
 +
 Appears first, gone in 4-6 weeks
VCA-IgG – + + If negative susceptible, it appears within a week of infection, then present for life
EBNA-IgG

+ Becomes positive in 2 – 4 months, then present for life
EA-D IgG   + + Positive in about a week, usually gone in 2 weeks, persists in 20% of people
Heterophile IgM (Mono test)   +   Associated with Mono, false positives with other conditions, false negatives common in children

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Is there anything else I should know?

There are at least two other antibodies that arise during an EBV infection - an IgA antibody to the EBV viral capsid antigen (EBV VCA-IgA) and an IgG antibody to the EBV early antigen restricted (EA-R IgG). While it is possible to test for these antibodies as part of the EBV diagnostic workup, it is rarely necessary to do so.

The most common complication of Mono is a ruptured spleen. Other complications of EBV infection that can occur include trouble breathing due to a swollen throat, strep throat at the same time, and, rarely, jaundice, skin rashes, pancreatitis, seizures, and/or encephalitis. EBV is also associated with, and may play a role in, several rare forms of cancer, including Burkitt’s lymphoma and nasopharyngeal carcinoma.

Reactivation of the virus is rarely a health concern unless the patient is significantly and persistently immune compromised, as may happen in those who have HIV/AIDS or in those who have received an organ transplant. Primary infections in these patients can be more severe, and some may experience chronic EBV-related symptoms.

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Common Questions

1.  How is EBV infection/Mono treated?

Care is largely supportive, rest, treating the symptoms, and avoiding any contact sports or heavy lifting for several weeks to months to avoid spleen rupture. There are no anti-viral medications or vaccines available to speed healing or prevent infection.

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2.  Do adults get Mono?

They do, but it is rare because most have already been infected at an earlier age. When they do, they tend to have less lymph node swelling and sore throat and more liver enlargement and jaundice.

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3.  Do EBV infection and Mono occur throughout the world?

Yes. In less developed nations, however, Mono is not as common because most of the population is infected with EBV earlier in life when symptoms are minimal.

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4.  Can EBV be prevented?

Not at this time. It is too common in the population and, because the virus will reactivate intermittently in a previously infected person, usually without causing any symptoms, almost everyone is infectious at one time or another.

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5.  If I have had EBV infection, can I still get Mono?

No. Once you have had an EBV infection, you will not get Mono. You could, however, experience similar symptoms from another viral illness.

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6.  Why is Mono sometimes called “the kissing disease”?

This is because EBV does not pass through the air; it is present in saliva and is passed through mouth-to-mouth contact and, in the case of children, through saliva transfer to hands and/or toys, etc.

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7.  Are there other types of tests available for EBV?

Yes. There are molecular tests that can detect and measure EBV DNA. They can be helpful in diagnosing and monitoring EBV-related diseases such as Burkitt’s lymphoma, Hodgkin’s lymphoma and post-transplant lymphoproliferative disease (PTLD).

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Article Sources

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby’s Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 401-403.

Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp 1556-1557.

Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition]. Pp 663.

Smith, D. S. (2007 August 6). Epstein-Barr virus test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003513.htm. Accessed on 11/23/08.

Bennett, N. J. and Domachowske, J (2008 August 12). Mononucleosis and Epstein-Barr Virus Infection. EMedicine [On-line information]. Available online at http://www.emedicine.com/ped/TOPIC705.HTM through http://www.emedicine.com. Accessed on 11/23/08.

(© 2006-2008). Epstein-Barr Virus – EBV. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/InfectiousDz/Viruses/EBV.html through http://www.arupconsult.com. Accessed on 11/23/08.

Mayo Clinic Staff (2008 June 28). Mononucleosis. MayoClinic [On-line information]. Available online at http://www.mayoclinic.com/health/mononucleosis/DS00352 through http://www.mayoclinic.com. Accessed on 11/23/08.

(2005 November). Infectious Mononucleosis. The Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec14/ch189/ch189f.html?qt=EBV&alt=sh through http://www.merck.com. Accessed on 11/23/08.

Peridin F, et. al (Published online 2007 March 28). Comparison of commercial and in-house Real-time PCR assays for quantification of Epstein-Barr virus (EBV) DNA in plasma. BMC Microbiol. 2007; 7: 22. Available online at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=pmc1852802 through http://www.pubmedcentral.nih.gov. Accessed January 2009.

(Updated Feb 2, 2009) Centers for Disease Control and Prevention. Epstein-Barr Virus and Infectious Mononucleosis. Available online at http://www.cdc.gov/ncidod/diseases/ebv.htm through http://www.cdc.gov. Accessed February 2009.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO. Pp 373-375.

Ebell, M. (2004 October 1). Epstein-Barr Virus Infectious Mononucleosis. American Family Physician [On-line journal]. Available online at http://www.aafp.org/afp/20041001/1279.html through http://www.aafp.org.

Levy, D. (2004 January 19, Updated). Epstein-Barr virus test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003513.htm.

(© 1995-2005). Epstein-Barr Virus Infection. The Merck Manual- Second Home Edition [On-line information]. Available online at http://www.merck.com/mmhe/sec17/ch198/ch198f.html through http://www.merck.com.

(© 2005). Epstein-Barr Virus. ARUP’s Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.aruplab.com/guides/clt/tests/clt_a238.jsp#1147825 through http://www.aruplab.com.

Schmid, S., Leader Herpesvirus Group (2005 September 13, Updated). Epstein-Barr Virus and Infectious Mononucleosis. CDC, National Center for Infectious Diseases [On-line information]. Available online at http://www.cdc.gov/ncidod/diseases/ebv.htm through http://www.cdc.gov.